CT引导下经皮肺穿刺活检失误分析及经验总结  

Summary of lapse analysis and experience with CT-guided percutaneous lung biopsy

作　　者：丁振兴 侯永乐 刘圣杰 李林[1] DING Zhenxing;HOU Yongle;LIU Shengjie;LI Lin(Department of Thoracic Surgery,Tianjin TEDA Hospital,Tianjin 300457,China)

机构地区：[1]天津市泰达医院胸外科,天津300457

出　　处：《实用放射学杂志》2024年第2期293-296,共4页Journal of Practical Radiology

摘　　要：目的探讨CT引导下经皮肺穿刺活检(CT-PTNB)过程中出现的并发症及其与操作不当的相关性。方法收集行肺肿物穿刺活检的360例患者临床资料,总结在穿刺活检过程中出现的并发症并分析其与操作不当的相关性,进一步汇总经验从而增加穿刺活检成功率,减少并发症的发生。结果360例患者均穿刺成功获得活检组织,穿刺后出现并发症者84例,其中气胸67例、出血59例(咯血5例、针道出血伴肺内出血59例、胸腔内出血6例)、胸壁皮下气肿9例、胸壁穿刺点疼痛3例,以上均未行手术治疗,经术后卧床休息、止血、抗感染、吸氧等对症治疗后恢复;只有6例气胸患者术后气胸量增加,行胸腔闭式引流术,术后均成功拔管;未出现空气栓塞等罕见并发症。结论应根据患者的不同情况选择合适的穿刺路径,同时应熟悉胸壁及肺部的解剖,注重穿刺活检过程中各个细节,减小失误的发生。Objective To investigate the complications of CT-guided percutaneous lung biopsy(CT-PTNB)and its correlation with improper operation.Methods The clinical data of 360 patients who underwent lung tumor needle biopsy were collected.The complications occurred in the process of needle biopsy and their correlation with improper operation were summarized,and the experience was further summarized to increase the success rate of needle biopsy and reduce the occurrence of complications.Results Biopsy tissue was successfully obtained in all 360 patients.There were 84 cases with complications after puncture,including 67 cases with pneumothorax,59 cases with hemorrhage(5 cases with hemoptysis,59 cases with needle tract hemorrhage with pulmonary hemorrhage,6 cases with intrathoracic hemorrhage),9 cases with subcutaneous emphysema of chest wall,and 3 cases with chest wall puncture point pain,and all patients did not undergo surgical treatment.All patients recovered from symptomatic treatment such as bed rest,hemostasis,anti-inflammatory and oxygen inhalation.Only 6 patients with pneumothorax had increased volume of pneumothorax after operation and underwent closed thoracic drainage,and all of them were decannulated successfully.No air embolism and other rare complications occurred.Conclusion The appropriate puncture path should be selected according to the different conditions of the patient.At the same time,the anatomy of the chest wall and lung should be familiar with,and pay attention to all the details of the needle biopsy process to reduce the occurrence of errors.

关 键 词：肺穿刺活检 穿刺路径 体表定位 并发症 操作不当 

分 类 号：R446.8[医药卫生—诊断学] R815[医药卫生—临床医学]